Objective To estimate the risk of term pre-eclampsia (PE) in women who screened positive for preterm PE in the first trimester and to assess the impact of screening method and timing of delivery on the risk of developing term PE. Design Retrospective observational cohort study. Setting Tertiary referral hospital in London, United Kingdom. Population A total of 1802 women with singleton pregnancies screened for PE using maternal risk factors per NICE guidelines and who delivered at term (≥37 weeks’ gestation). Methods The Fetal Medicine Foundation (FMF) combined screening algorithm was retrospectively applied to the cohort using maternal risk factors, mean arterial pressure (MAP), and pregnancy-associated plasma protein-A (PAPP-A). Women were stratified by FMF screening result and timing of delivery. Outcomes were compared between those delivering before 40 weeks and those delivering at or after 40 weeks. Main Outcome Measures The primary outcome was incidence of term PE. Secondary outcomes included pregnancy-induced hypertension, low birthweight, birthweight centile, emergency caesarean section, and neonatal admissions. Results FMF screening identified 12.4% of women as screen-positive versus 9.4% with NICE. Among FMF screen-positive women, term PE incidence was significantly higher in those delivering at ≥40 weeks compared to those delivering at 37 +0–39 +6 weeks (28% vs. 13.4%, p = 0.008). Delivery at 38 +0–39 +6 weeks prevented one PE case per seven women; delivery at 39 +0–39 +6 weeks prevented one case per six. Conclusions Timed delivery before 40 weeks in FMF screen-positive women may significantly reduce the risk of term PE. Further studies are needed to optimise delivery strategies for this population.

Objective: Investigate cost effectiveness of first trimester preeclampsia screening using the Fetal Medicine Foundation (FMF) algorithm in comparison to standard care. Design: Retrospective observational study Setting: London tertiary hospital Population: 5957 pregnancies screened for preeclampsia using the National Institute for Health and Care Excellence (NICE) method. Methods: Differences in pregnancy outcomes between those who developed preeclampsia, term preeclampsia and preterm preeclampsia were compared by the Kruskal-Wallis and Chi-square tests. The FMF algorithm was applied retrospectively to the cohort. A decision analytic model was used to estimate costs and outcomes for pregnancies screened using NICE and those screened using the FMF algorithm. The decision point probabilities were calculated using the included cohort. Main outcome measures: Incremental healthcare costs and QALY gained per pregnancy screened. Results: Of 5957 pregnancies, 12.8% and 15.9% were screen positive for the development of preeclampsia using the NICE and FMF methods, respectively. Of those screen positive by NICE recommendations, aspirin was not prescribed in 25%. Across the three groups: pregnancies without preeclampsia, term preeclampsia and preterm preeclampsia, respectively there was a statistically significant trend in rates of emergency caesarean (21%, 43%, 71.4%; p=<0.001), admission to neonatal intensive care unit (NICU) (5.9%, 9.4%, 41%; p=<0.001) and length of stay in NICU. Use of the FMF algorithm was associated with 7 fewer cases of preterm preeclampsia, cost saving of £9.06 and a QALY gain of 0.00006/pregnancy screened. Conclusions: In our cohort, using a conservative approach, application of the FMF algorithm achieved clinical benefit and an economic cost saving.

Objectives: Assess first trimester serum placental growth factor (PLGF), soluble fms-like tyrosine kinase-1 (sFLT-1), interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), endothelin and vascular cell adhesion molecule (VCAM) in women with chronic hypertension (CH) stratified according to blood pressure (BP) control. Design: Case-control. Setting: Tertiary referral centre. Population: 650 women with CH, 142 normotensive controls. Methods: In the first trimester, patients with CH were subdivided into 4 groups. Group 1 included women without pre-pregnancy CH presenting with BP ≥140/90mmHg. Groups 2-4 had pre-pregnancy CH; in group 2 the BP was <140/90mmHg without antihypertensive medication, in group 3 the BP was <140/90mmHg with antihypertensive medication and in group 4 the BP was ≥ 140/90 mmHg despite antihypertensive medication. PLGF, sFLT-1, IL-6, TNF-α, endothelin and VCAM were measured at 11+0-13+6 weeks’ and converted into multiples of the expected median (MoM) using multivariate regression analysis in the controls. Main outcome measure: Comparisons of MoM values of PLGF, sFLT-1, IL-6, TNF-α, endothelin and VCAM between the 4 CH groups and the controls were made using analysis of variance or Kruskal-Wallis tests. Results: In the CH groups, compared to controls, PLGF was reduced in groups 2-4, sFLT-1 was reduced in groups 2 and 3, endothelin was increased in groups 1 and 4 but IL-6 was reduced in group 4. Conclusion: In women with CH, differences exist in first trimester angiogenic and inflammatory profiles according to BP control. Further evaluation is needed to determine if these differences are useful in the stratification of care.

Coronavirus Disease 19 (COVID-19) is caused by severe acute respiratory coronavirus-2 and has resulted in an unprecedented global pandemic. The adaptations of pregnancy often predispose pregnant women to a more severe course of respiratory illness with the potential for maternal and perinatal morbidity. Thus, national and international guidelines are rapidly being developed to help maintain optimal care throughout pregnancy. Due to the novelty of COVID-19 and limitations of existing data, heterogeneity exists between these guidelines. We aim to review the available evidence for the management of pregnant women with COVID-19 and summarise the recommendations set out by three main institutions.